Identification of effective and ineffective learning behaviors in clinical settings: Use of the critical incident technique

Background. Providing practical educational experiences for individuals training for the health professions as they prepare to enter practice requires a continual appraisal of the teaching and learning that occurs within these settings. One method that has been used to collect information about these experiences is the Critical Incident Technique. However, it has not been used to compare the most critically effective and the most critically ineffective incidents of medical students and physicians in office-based settings. This study sought to make those comparisons and identify concordant and discordant themes between groups.;Method. Two groups were sampled. Sixty-one third-year medical students completing a 6-week rotation in Family Medicine and 19 physicians who precept (teach) the 61 students were sampled. Medical students were asked to complete a questionnaire at the conclusion of the 6-week rotation and preceptors were contacted by the investigator to participate in a one-on-one telephone interview at the conclusion of the rotation.;Results. Thirty-six (59%) medical students and 11 (58%) of the physicians participated in the study. Response data was entered into ACCESS databases and organized by incident type (effective and ineffective) and respondent group (medical student and physician). Responses were reviewed by the investigator on two occasions and by three external, expert reviewers. Category codes were developed to summarize the content of the critical incidents and frequency and rank information was generated.;For the most critically effective incidents, both medical students and physicians identified incidents that addressed Supervised Independent Patient Care (36%). For the most critically ineffective incidents, both medical students and physicians identified scenarios regarding Personal Characteristics (12% and 45%, respectively) and Required Clerkship Assignments (32% and 27%, respectively). Some gender differences were noted and are discussed at length in the following pages.;Interpretation. The findings from this study provide insight into the clinical experiences that were deemed by both respondent groups as the most critically effective and the most critically ineffective. The similarities and differences between and within groups will be used to attain consensus as to those aspects of the curriculum that benefit medical students' learning experiences, while maximizing preceptors' teaching experiences.